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Are you considering enrolling in a Medicare Advantage plan in Puerto Rico? You're in good company. In 2023, more than 31 million people are expected to get a private Medicare health plan. Some want lower costs. Some are looking for more benefits. Others need access to more healthcare providers.
If you’re looking for the best Medicare Advantage plan in your Puerto Rico community, that suits your individual needs, MedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. is here to assist. Using the overview of the Puerto Rico market below, you will get a clear understanding of your top plan options, who the top-rated plan providers are, and how much you should expect to pay each month for a plan.
NOTE: Our analysis does not include Puerto Rico's Medicare Advantage SNP Plans. We evaluate these plans separately. We also did not include plans without Medicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... benefits, employer plans, or Medicare-Medicaid Plans (MMPs).
Call 1-855-728-0510 (TTY 711) for assistance. There's no obligation.
Who Has The Best Medicare Advantage Plans in Puerto Rico?
Each year, the The Centers for Medicare & Medicaid Services (CMS) is the U.S. Federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs. (CMS), rates Puerto Rico's Medicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). based on a 5-star scale. The information used to create a plan's star rating comes from member input and data reported by the plan.
There are no 5-star plans in Puerto Rico in 2023. However, there are 4.5-star plans. This year, the highest rated Medicare plans available in Puerto Rico come from:
- PMC Medicare Choice
- MMM Healthcare
MedicareWire recommends that you evaluate the plans offered by these Puerto Rico providers, before all others, for this single reason. More stars awarded by CMS typically means members get better results. So, for instance, five-star plan members might receive better service and care than those who have a four-star plan.
TIP: Everyone's personal situation is different. And so are Puerto Rico's Medicare Advantage plans. That's why it is so important to understand the downside to Medicare Advantage plans.
Complete List of Puerto Rico's 2023 Medicare Advantage Plan Providers
Puerto Rico has 6 providers that offer Medicare Advantage plans. They include:
- MCS Classicare
- Medicare y Mucho Ms
- MMM Healthcare
- PMC Medicare Choice
- Triple S Advantage
Top Puerto Rico Medicare Advantage Plans by CMS 5-Star Score in 2023
Here's a list of the best 2023 Medicare Advantage plans available in Puerto Rico, according to the Centers for Medicare & Medicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. Services:
Top Medicare Advantage Plans in Puerto Rico
|Provider||Plan ID||Plan Name||Premium||Limit||Stars|
|Humana||H4007-012||Humana Gold Plus H4007-012 (HMO)||$0.00||$5,000||4.5|
|Humana||H4007-020||Humana Gold Plus H4007-020 (HMO)||$0.00||$5,000||4.5|
|Humana||H4007-021||Humana Gold Plus H4007-021 (HMO)||$0.00||$5,000||4.5|
|Humana||H4007-024||Humana Gold Plus H4007-024 (HMO)||$0.00||$5,000||4.5|
|Humana||H4007-025||Humana Gold Plus H4007-025 (HMO)||$0.00||$5,000||4.5|
|PMC Medicare Choice||H4004-063||MMM Balance (HMO-POS)||$0.00||$3,250||4.5|
|PMC Medicare Choice||H4004-065||MMM Plenitud (HMO-POS)||$0.00||$3,250||4.5|
|PMC Medicare Choice||H4004-056||PMC Max (HMO-POS)||$0.00||$3,250||4.5|
|MCS Classicare||H5577-051||MCS Classicare Metro (HMO)||$0.00||$3,400||4.0|
|MCS Classicare||H5577-050||MCS Classicare Acceso (HMO-POS)||$0.00||$3,400||4.0|
|MCS Classicare||H5577-031||MCS Classicare Activo (HMO)||$0.00||$3,400||4.0|
|MCS Classicare||H5577-005||MCS Classicare Efectivo (HMO)||$0.00||$3,400||4.0|
|MCS Classicare||H5577-049||MCS Classicare Electrico (HMO)||$0.00||$3,400||4.0|
|MCS Classicare||H5577-047||MCS Classicare En Tu Casa (HMO)||$0.00||$3,400||4.0|
|MCS Classicare||H5577-043||MCS Classicare En Tu Hogar (HMO)||$0.00||$3,400||4.0|
|MCS Classicare||H5577-008||MCS Classicare Essential (HMO-POS)||$0.00||$3,400||4.0|
|MCS Classicare||H5577-053||MCS Classicare Exacto (HMO)||$0.00||$3,400||4.0|
|MCS Classicare||H5577-042||MCS Classicare Firme (HMO)||$0.00||$3,400||4.0|
|MCS Classicare||H5577-014||MCS Classicare Freedom (HMO)||$0.00||$6,700||4.0|
|MCS Classicare||H5577-044||MCS Classicare Hero (HMO)||$0.00||$3,400||4.0|
|MCS Classicare||H5577-052||MCS Classicare InteliCare (HMO)||$0.00||$3,400||4.0|
|MCS Classicare||H5577-039||MCS Classicare SuperRx (HMO)||$0.00||$3,400||4.0|
|Medicare y Mucho Ms||H4003-054||MMM Encanto (HMO-POS)||$0.00||$3,250||4.0|
|Medicare y Mucho Ms||H4003-055||MMM Deluxe (HMO-POS)||$0.00||$3,250||4.0|
|Medicare y Mucho Ms||H4003-051||MMM Dinamico (HMO-POS)||$0.00||$3,250||4.0|
|Medicare y Mucho Ms||H4003-034||MMM Elite (HMO-POS)||$0.00||$3,250||4.0|
|Medicare y Mucho Ms||H4003-057||MMM Flexi Max (HMO-POS)||$0.00||$3,250||4.0|
|Medicare y Mucho Ms||H4003-019||MMM Unico (HMO-POS)||$15.00||$3,250||4.0|
|Triple S Advantage||H5774-038||Enlace Plus (HMO)||$0.00||$3,650||4.0|
|Triple S Advantage||H5774-027||Magno (HMO-POS)||$0.00||$3,650||4.0|
|Triple S Advantage||H5774-005||Real (HMO)||$0.00||$3,650||4.0|
|Triple S Advantage||H5774-037||AhorroMax (HMO)||$0.00||$3,650||4.0|
|Triple S Advantage||H5774-031||Brillante (HMO-POS)||$0.00||$3,650||4.0|
Interested in joining a plan from one of the top-rated providers? That has a lot to do with your Puerto Rico Municipio. Medicare Advantage plans are regional, and you can't join a plan that isn't in your area.
Best 2023 Medicare Advantage Plans by Puerto Rico Municipio
Choose your Puerto Rico Municipio below to see the best (and the worst) 2023 plans.
For fast, friendly assistance call 1-855-728-0510 (TTY 711) .
How to Choose the Best Medicare Advantage Plan in Puerto Rico
If you’re approaching the age of 65, navigating a special enrollment event, or looking to review your plan options ahead of the The Annual Enrollment Period is when Medicare beneficiaries can join, drop or change Medicare Advantage and Medicare Part D prescription drug plans. AEP begins on 15 October and ends on 7 December., there are a number of details you need to consider when comparing your options.
1. Consider Your Expected Utilization
Do you believe that you will get the most out of your plan's benefits? If you do, evaluate plans with higher monthly A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , low A copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service., and low maximum out-of-pocket limits. Conversely, if your health is good and you rarely use services, look for plans with low premiums or a zero-dollar premium. These plans may have high out-of-pocket maximums and high A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., so weigh your risk carefully.
2. Evaluate Your Prescription Costs
Prescriptions are what many people blame for driving up their healthcare costs. Part D prescription benefits are included with most Medicare Advantage plans. It would be best if you made sure that the plan you choose covers your medication at a price you can afford.
3. Understand Your Additional Coverage Needs
Original Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. does not all health care costs. It covers your major medical and some preventive care services, but it does not cover dental, vision, hearing, or prescriptions. A growing number of Medicare Advantage plans cover many of the essential services that your Part A and Medicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. benefits do not.
4. Consider Your Healthcare Providers
Medicare Advantage plans use healthcare provider networks, and not all primary care doctors and specialists accept all plans. For many Puerto Rico shoppers, finding a plan that their doctor(s) accept is exhausting. We can help!
Should I Choose an HMO or PPO plan?
There are many plan options available when shopping for Medicare Advantage plans in Puerto Rico, including HMO and PPO options. These are some of the differences you should consider before making a plan selection.
- With an HMO you may pay less out-of-pocket, but you will need to choose a primary physician to coordinate your care. Referrals for specialists are often required. Except in an emergency, you must remain within the provider network.
- With a PPO you are not required to get referrals for specialty care. You have the option to get health care outside of the plan's provider network. However, typically you will pay more and the out-of-pocket maximum for out-of-network care will be higher.
Need help choosing? Call 1-855-728-0510 (TTY 711) for plan assistance. There's no obligation.
Find Plans in your area with your ZIP Code
Frequently Asked Questions
Still have questions? These common questions and answers might help. Or, call 1-855-728-0510 (TTY 711) to speak with a licensed advisor.
What is the biggest disadvantage of Medicare Advantage?
Medicare Advantage plans can have some potential drawbacks. Many plans require members to use their provider network. Costs are also heavily influenced by how you use healthcare services. This makes it difficult to budget for healthcare expenses. Most plans require members to get referrals for specialists or authorization before they can receive healthcare services. Learn more about the pros and cons of Medicare Advantage plans.
Do Medicare Advantage plans pay 100% of all costs?
The average cost of a Medicare Advantage plan in Puerto Rico is $2.58. But that's just the monthly premium. If you have one or more chronic health conditions, a plan's Out-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. (e.g. deductibles and copays) are also a factor to consider. Plus, most Medicare Advantage plans include prescription drug benefits, which have their own out-of-pocket costs.
What do Medicare Advantage plans include?
All Medicare Advantage plans offered in Puerto Rico must cover all of the Original Medicare benefits. But, private Medicare plans are not required to provide healthcare services similarly. For instance, Medicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. covers 80% of hospital stays, skilled nursing, home care, Hospice is a special way of caring for people who are terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. care, and Health care services and supplies a doctor decides you may receive in your home under a plan of care established by your doctor. Medicare only covers home health care on a limited basis as ordered.... And Part B covers 80% of doctor visits, lab tests, and other outpatient services. However, Medicare Advantage plans are allowed to set their own copays and routinely charge more than 20%. That said, they do have an annual limit, whereas Original Medicare doesn't.
Methodology and Sources
Our analysis of the top-rated Medicare Advantage plans in Puerto Rico excludes employer group plans, Medicare-Medicaid Plans (MMPs), Medicare Savings Account Plans (MSAs), Special Needs Plans (SNPs), and plans that do not include Part D benefits.
CMS rates health plans in several categories, including delivery of health care, member experience and customer service. When comparing plan ratings, we use state-specific data, not CMS' nationwide figures.
Medicare Advantage plan data is sourced from CMS public use files (see: Citations & References). When needed, we combined affiliated companies to calculate insurer averages.
Citations & References
- CMS.gov, 2023 Medicare Part C Landscape Source Files, Last Accessed October 15, 2022
- CMS.gov, "5-STAR PLAN RATINGS", Last Accessed October 22, 2022
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed October 16, 2022
- KFF.org, "Medicare Advantage 2022 Spotlight: First Look", Last Accessed November 2, 2021
- Medicare.gov, "How to join a Medicare Advantage Plan", Last Accessed October 11, 2022
- CMS.gov, Part C and D Performance Data, Last Accessed October 19, 2022
- CMS.gov, Monthly MA Enrollment by State/County/Contract, Last Accessed October 1, 2022
- CMS.gov, Biden-Harris Administration Announces Lower Premiums for Medicare Advantage and Prescription Drug Plans in 2023, Last Accessed September 29, 2022
This Medicare Advantage state information page was last updated on .